Exam 3- PNF part 2 Flashcards
shoulder and pelvic girdle
~Anterior depression and posterior elevation
~Anterior elevation and posterior depression
some details when doing PNF
~No matter how much they have action the pt has, always start passively
~Need to have the pt relax to move them through passively
~make sure to assure them that you will not drop them
~Talk them though what you are doing (verbal), have them watch (visual), then have them do it
~Make sure to grab the distal part of the limb
RI- what does it stand for
Rhythmic initiation
RI- Description
movement is first passive, then progressive to active assisted, then to active motion thru increments of range
RI- Basis
~slow rhythmical motion acts to inhibit arousal (RAS) and achieve relaxation
~movement is thru the available range, avoiding a protective response from pt
~movement is slow and maintained, avoiding quick stretches
RI- Application
~pts who are unable to initiate movement due to increased tone
~use to teach an activity
~pts with limited ROM due to increased tone
RI- other info
~How we should teach a pt how to teach a PNF pattern
~May have to do in passive stage for longer when pt has high tone; if we want to relax the pt
~Painful pts- can help the pt relax with a lot of slow passive movements (guarding)
RR- what does it stand for?
Rhythmic rotation
RR- Description
~the pt is relaxed
~the PT slowly and passively moves the part thru range while slowly rotating and derotating the part on its axis
RR- Basis
~slow and rhythmical motion acts to inhibit (RAS)
~rotary movements seam to unlock and relax muscle
RR- Application
~for pts whose spasticity increases markedly with active movement
~pts with spasticity and no active movement
RR- other info
~Add a rotary component
~Can unlock jt even more- try and help the pt relax and get them to move even more
HRAM- what does it stand for?
Hold relax active movement
HRAM- Description
~ISOMETRIC contraction in shortened range of a pattern against graded resistance the HOLD is build up
~pt is given RELAX command
~when PT feels pt relax, PT quickly movements pt to lengthened range of pattern
~applying a quick stretch, PT gives appropriate command to have pt ACTIVELY return to shortened range of pattern
~PT may assist, track, or resist during active phase
HRAM- Basis
~hold is short range increases muscle spindles sensitivity so that during the quick stretch in the lengthened range muscle spindle discharge is maximized
~commands are given in appropriate manner to facilitate arousal via RAS
~resistance during active phase stimulate isotonics
HRAM- Application
pt with weakness and/or unable to initiate movement from lengthened range
HRAM- other info
~Lengthened- Physiological overflow- easier to create a contraction
~hoping that the neuro will learn to contract from a more lengthen position
~Hoping that the isometric buildup will help cue the nervous system that this is the muscle they are trying to contract at a more stretched position (where it is having difficulty contracting at a lengthened state - lengthened sarcomeres).
~Helpful for total knee pts
HR- what does it stand for?
Hold relax
HR- Description
~technique is performed at the point of limitation in range
~pt may actively move to (or passively) that point of limitation the PR resists ISOMETRIC contraction for the range-limiting pattern; resistance is built up to pt tolerance (maximal) and then maintained (no jt motion is allowed)
~command to RELAX is given as the resistance is changed to support the part
~when relaxation is felt, the pt is asked to actively more into the desired motion
HR- Basis
~GTO firing will inhibit the range limiting pattern
~having pt activity move into desired pattern will result in reciprocal inhibition of the range limiting pattern
HR- Application
~when pt has pain on movement
~used when involved joint does not have a large rotary component
HR- other info
~If you push the muscle to fatigue so that you can get the ROM
~Will guard bc they will don’t want to go into the range
~If the jt has a large rotary comp, can do CR
CR- what does it stand for?
Contract relax
CR- Description
~technique is done at the point of limitation in range
~pt actively moves to that point
~PT resists the range limiting pattern such that an ISOTONIC contraction for rotary component and an ISOMETRIC contraction of the other components are achieved
~when the pt has moved thru the full range of the rotary motion, the command to RELAX is given as the resistance is changed to support the limb
~when relaxation has occurred, the pt moves to the new range, or is passively moved by PT
CR- Basis
~when pt actively moves to range limited pattern point, the range limiting pattern is reciprocally inhibited
~rotatory movements appear to unlock or relax; GTO inhibit range limited pattern
CR- Application
when involved joint has large rotary component and when motion does not increase pain
CR- other info
~Add rotation
~what to do a large rotary component- we are fatiguing the 2 muscles groups that are preventing the movement
~If problem with flex and IR, push into flex then ER all the way then flex and IR at the same time
AI- what does it stand for?
Alternating isometrics
AI- Description
~intermediate step to RS
~pt resists an ISOMETRIC contraction of one pattern immediately followed with resistance to ISOMETIC contraction of antagonist pattern
~resistance is built up within each shift and over entire sequence
AI- Application
use for balancing tone; when used for this purpose, one side of joint is emphasized, often used in trunk stabilization
AI- other info
~Build stability or jt or jts; great for the trunk/ balance
~Like low grade perturbations
RS- what does it stand for?
Rhythmic stabilization
RS- Description
~simultaneous co-contraction (isometric) of antagonistic patterns (resisted flexion of elbow at wrist at the same time resisted extension of shoulder at extensor surface near elbow, then change) by alternating the antagonistic patterns resisted by each hand
~resistance is gradually built up within each shift and over the entire sequence
RS- Basis
~co-contraction effects both sides of the joint
~maintained resistance facilitates stabilization
RS- Application
when pt has limited ROM due to splinting or pain’ appropriate to develop stability of head, neck, and trunk
RS- other info
~AI with rotation in the trunk
SR- what does it stand for?
Slow reversals
SR- Description
~isotonic contraction of one pattern followed by an isotonic contraction of the antagonist pattern
~movements are slow and rhythmical
~resistance may be used, but is usually minimal
SR- Basis
the slow rhythmical movements inhibit arousal via RAS, resistance stimulates activation
SR- Application
~to teach an activity
~when pt has weakness limiting ability to initiate movement
~when increased tone limits initiation of movement or motion thru range
SR- other info
D1 flex, D1 ext- do one action then the opposite movement (slowly)
SRH- what does it stand for?
Slow reversal hold
SRH- Description
~pt isotonically contracts the agonist, followed by and isometric contraction of the agonist
~pt changes direction (reversal) by repeating same sequence of contractions of the antagonist
~pattern does not relax before shifting to opposing pattern
SRH DEC- description
thru decrement of range- the PT gradually decreases the amount of ROM that the pt moves thru
SRH INC- description
thru increment of range- the PT gradually increases the amount of ROM that the pt moves thru
SRH- Basis
aids in the transition from mobility to stability
SRH- Application
to develop endurance and strength within a pattern of movement
SRH DEC- application
when a pt cannot stabilize (ataxic) builds up the ability to stabilize
SRH INC- application
~when a pt does not have control thru the full range of an activity
~builds up ability to move through full range with control
SRH- other info
Usually done on a pt with ataxia- pt has movement, but somewhere in the range, the movement does not have the ability to do what they want it to/ there is not stability in the range
SRH DEC- other info
~decrease the range of movement that the pt gets to do at first and then they will increase when they are able to do it better
~do isometrics at the end of the range where they are still stable
SRH INC- other info
slowly increase as the movement becomes more stable
AR- what does it stand for?
Agonistic reversal
AR- Description
~a rhythmical reversal from shortening to lengthening contractions of a muscle group
~start out slowly
~Concentric to Isometric to Eccentric to Isometric contractions
AR- Basis
rhythmical slow movement is used to promote functional stability in a smooth manner
AR- Application
~use when weakness prevents the pt from controlling his body thru the full range of a lengthening contraction
~use when spasticity interferes with the pt’s ability to perform lengthening contractions
AR- other info
~Go through range concentrically then eccentrically
~hold isometic at top and bottom
~good with bridges
~Can do in tall kneeling and quads
RP- what does it stand for?
Resisted progression
RP- Description
resisted isotonic movement in a pattern of locomotion (gait)
RP- Basis
resistance results in overflow
RP- Application
~use to develop endurance
~use to promote motor learning of an activity
~use too develop strength
RP- other info
~Crawling, tall knelling, and gait
~pulling as they are moving hips/ knees/ hands/ etc
RC- what does it stand for?
Repeated contraction
RC- Description
~pt isotonically contracts the weak pattern
~isometric contraction is asked for at the point for at the point the pattern deteriorates
~isometric is built up
~quick stretch is applied to the whole pattern as the pt is asked to move again
~at the end of the range, an isometric contraction is performed; the sequence is repeated
RC- Basis
muscle spindle facilitation and overflow
RC- Application
use when pt has weakness of whole pattern
RC- other info
~Forcing more muscle spindles to fire
~Need to relearn the movement patterns
